中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (3): 609-616.doi: 10.12307/2025.130

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

不同运动类型对膝骨关节炎患者疗效的网状Meta分析

李  佳1，刘倩茹1，邢梦楠1，陈  波2，矫  玮1，孟兆祥2   

  1. 1北京体育大学运动医学与康复学院，北京市   100000；2 江苏省苏北人民医院康复医学科，江苏省扬州市   225000
  • 收稿日期:2023-12-19 接受日期:2024-02-18 出版日期:2025-01-28 发布日期:2024-06-04
  • 通讯作者: 矫玮，博士，教授，博士生导师，北京体育大学运动医学与康复学院，北京市 100000 并列通讯作者：孟兆祥，博士，主任医师，博士生导师，江苏省苏北人民医院康复医学科，江苏省扬州市 225000
  • 作者简介:李佳，女，1996年生，江苏省扬州市人，汉族，北京体育大学在读硕士，主要从事运动康复方向的研究。
  • 基金资助:
    江苏省卫健委面上项目(H2023006)，项目负责人：陈波

A network meta-analysis on therapeutic effect of different types of exercise on knee osteoarthritis patients

Li Jia1, Liu Qianru1, Xing Mengnan1, Chen Bo2, Jiao Wei1, Meng Zhaoxiang2   

  1. 1College of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100000, China; 2Department of Rehabilitation Medicine, Subei People’s Hospital of Jiangsu Province, Yangzhou 225000, Jiangsu Province, China
  • Received:2023-12-19 Accepted:2024-02-18 Online:2025-01-28 Published:2024-06-04
  • Contact: Jiao Wei, MD, Professor, Doctoral supervisor, College of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100000, China Co-corresponding author: Meng Zhaoxiang, MD, Chief physician, Doctoral supervisor, Department of Rehabilitation Medicine, Subei People’s Hospital of Jiangsu Province, Yangzhou 225000, Jiangsu Province, China
  • About author:Li Jia, Master candidate, College of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100000, China
  • Supported by:
    General Program of Health Commission of Jiangsu Province, No. H2023006 (to CB)

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摘要：

文题释义：
膝骨关节炎：是一种以膝关节软骨退行性病变和继发性骨质增生为特征的慢性关节疾病，多发于中老年人群，膝骨关节炎症状进展缓慢，随着时间推移逐渐出现膝关节疼痛、肿胀、僵硬及畸形等，导致患者活动障碍，严重者可完全无法行动。
网状Meta分析：指利用包含3种及以上干预措施构成的证据体里的所有研究，结合直接比较和间接比较，基于Meta分析技术进行加权合并分析。该方法可同时比较证据体中多个干预措施之间治疗效果差异，并按效果大小进行排序，从而为决策者制定临床指南提供重要参考依据。

摘要
目的：膝骨关节炎的主要临床表现为疼痛、肿胀、僵硬以及活动受限，对患者生活造成了严重影响，运动疗法可以有效改善膝骨关节炎患者的相关症状。文章运用网状Meta分析的方法，比较不同类型运动治疗膝骨关节炎的疗效。
方法：检索中国知网、万方、PubMed、Embase、Cochrane Library、Web of Science、Scopus、Ebsco、SinoMed及UpToDate等数据库，中文检索词为“膝骨关节炎，运动疗法”等，英文检索词为“Knee Osteoarthritis，Exercise”等，收集2013年10月至2023年10月有关不同运动类型在膝骨关节炎患者中应用的随机对照试验。结局指标包括目测类比评分、西安大略和麦克马斯特大学骨关节炎指数评分、定时起立行走测试、简明健康调查表-36项目等。使用Cochrane手册推荐的随机对照试验偏倚风险评估工具对纳入文献进行文献质量分析，由2位研究者独立完成数据的收集、整理提取及分析，使用RevMan 5.4和Stata 18.0软件对所得的数据进行分析与绘图。
结果：最终纳入29篇文献，文献质量尚可，共1 633例膝骨关节炎患者，涉及有氧训练、力量训练、柔韧性/技能训练和正念放松训练4种运动类型。①网状Meta分析结果显示：与常规护理/健康教育相比，有氧训练能显著改善疼痛症状(SMD=-3.26，95%CI：-6.33至-0.19，P < 
0.05)；力量训练(SMD=-0.79，95%CI：-1.34至-0.23，P < 0.05)、正念放松训练(SMD=-0.79，95%CI：-1.23至-0.34，P < 0.05)能显著提高患者的功能；有氧训练(SMD=-1.37，95%CI：-2.24至-0.51，P < 0.05)、正念放松训练(SMD=-0.41，95%CI：-0.80至-0.02，P < 0.05)能显著提高患者的功能性移动能力；正念放松训练(SMD=0.70，95%CI：0.21-1.18，P < 0.05)、力量训练(SMD=0.42，95%CI：0.03-0.81，P < 0.05)能显著提高患者的生活质量。②累积概率排序结果显示，疼痛方面：有氧训练(86.6%) >柔韧性/技能训练(60.1%) >力量训练(56.8%) >正念放松训练(34.7%) >常规护理/健康教育(11.7%)；膝关节功能方面：力量训练(73.7%) >正念放松训练( 73.1%) >柔韧性/技能训练(56.1%) >有氧训练(39.9%) >常规护理/健康教育(7.6%)；功能性移动能力方面：有氧训练(94.7%) >正念放松训练(65.5%) >力量训练(45.1%) >柔韧性/技能训练(41.6%) >常规护理/健康教育(3.2%)；生活质量方面：正念放松训练(91.3%) >力量训练(68.0%) >柔韧性/技能训练(44.3%) >有氧训练(34.0%) >常规护理/健康教育(12.3%)。
结论：①运动疗法治疗膝骨关节炎疗效显著，其中有氧训练在缓解患者疼痛和提高患者功能性移动能力上疗效最佳；力量训练和正念放松训练在改善患者功能上疗效最佳；正念放松训练在提高患者生活质量上疗效最佳。②受纳入文献质量和数量的限制，该研究结果尚需更多高质量的研究加以验证。

https://orcid.org/0009-0000-5564-3087 (李佳) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 膝骨关节炎, 有氧训练, 力量训练, 正念放松训练, 疼痛, 功能, 功能性移动能力, 生活质量, 网状Meta分析

Abstract: OBJECTIVE: The main clinical manifestations of knee osteoarthritis are pain, swelling, stiffness, and limited activity, which have a serious impact on the life of patients. Exercise therapy can effectively improve the related symptoms of patients with knee osteoarthritis. This paper uses the method of network meta-analysis to compare the efficacy of different exercise types in the treatment of knee osteoarthritis.
METHODS: CNKI, WanFang, PubMed, Embase, Cochrane Library, Web of Science, Scopus, Ebsco, SinoMed, and UpToDate were searched with Chinese search terms “knee osteoarthritis, exercise therapy” and English search terms “knee osteoarthritis, exercise”. Randomized controlled trials on the application of different exercise types in patients with knee osteoarthritis from October 2013 to October 2023 were collected. The outcome measures included visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index score, Timed Up and Go test, and 36-item short form health survey. Literature quality analysis was performed using the Cochrane Manual recommended tool for risk assessment of bias in randomized controlled trials. Two researchers independently completed the data collection, collation, extraction and analysis. RevMan 5.4 and Stata 18.0 software were used to analyze and plot the obtained data.
RESULTS: A total of 29 articles with acceptable quality were included, involving 1 633 patients with knee osteoarthritis. The studies involved four types of exercise: aerobic training, strength training, flexibility/skill training, and mindfulness relaxation training. (1) The results of network meta-analysis showed that compared with routine care/health education, aerobic training could significantly improve pain symptoms (SMD=-3.26, 95%CI: -6.33 to -0.19, P < 0.05); strength training (SMD=-0.79, 95%CI: -1.34 to -0.23, P < 0.05) and mindfulness relaxation training (SMD=-0.79, 95%CI: -1.23 to -0.34, P < 0.05) could significantly improve the function of patients. Aerobic training (SMD=-1.37, 95%CI: -2.24 to -0.51, P < 0.05) and mindfulness relaxation training (SMD=-0.41, 95%CI: -0.80 to -0.02, P < 0.05) could significantly improve the functional mobility of patients. Mindfulness relaxation training (SMD=0.70, 95%CI: 0.21-1.18, P < 0.05) and strength training (SMD=0.42, 95%CI: 0.03-0.81, P < 0.05) could significantly improve the quality of life of patients. (2) The cumulative probability ranking results were as follows: pain: aerobic training (86.6%) > flexibility/skill training (60.1%) > strength training (56.8%) > mindfulness relaxation training (34.7%) > routine care/health education (11.7%); Knee function: strength training (73.7%) > mindfulness relaxation training (73.1%) > flexibility/skill training (56.1%) > aerobic training (39.9%) > usual care/health education (7.6%); Functional mobility: aerobic training (94.7%) > mindfulness relaxation training (65.5%) > strength training (45.1%) > flexibility/skill training (41.6%) > routine care/health education (3.2%); Quality of life: mindfulness relaxation training (91.3%) > strength training (68.0%) > flexibility/skill training (44.3%) > aerobic training (34.0%) > usual care/health education (12.3%).
CONCLUSION: (1) Exercise therapy is effective in the treatment of knee osteoarthritis, among which aerobic training has the best effect on relieving pain and improving functional mobility. Strength training and mindfulness relaxation training has the best effect on improving patients’ function. Mindfulness relaxation training has the best effect on improving the quality of life of patients. (2) Limited by the quality and quantity of the included literature, more high-quality studies are needed to verify it.

Key words: knee osteoarthritis, aerobic training, strength training, mindfulness relaxation training, pain, function, functional mobile ability, quality of life, network meta-analysis

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